You may have received a notification to revalidate your Medicare enrollment, or heard others discussing Medicare revalidation, and were unsure what this process was, or if you were required to do anything. The Academy has put together some quick answers to your questions and links to resources to help you through the revalidation process.

What Is Medicare Revalidation?

Medicare revalidation is a required process completed at certain intervals to ensure provider enrollment records remain current. As part of the Affordable Care Act, audiologists are required to revalidate their Medicare enrollment every five years, or as requested by the Centers for Medicare and Medicaid Services (CMS). This process allows providers to verify the information contained in his or her Medicare enrollment record to ensure it is still accurate and compliant with Medicare regulations. 

Basically, revalidation is re-enrollment. 

How Do I Know When to Revalidate?

CMS advises providers to submit the needed documentation six months before the due date. This allows for processing time and prevents interruption in Medicare reimbursement. If you are enrolled as a provider under the Medicare program, you can check the Medicare Revalidation Lookup Tool to find your revalidation due date. Providers should receive notice from their Medicare Administrative Contractor (MAC) when he or she needs to revalidate. 

Off-cycle revalidation may be requested by CMS when a complaint is filed, concerns about local health-care fraud arise, or if a provider’s compliance with CMS regulations is in question.

What Is a Medicare Administrative Contractor and What Is the Process to Revalidate?

Your MAC is a private health-care insurer that has been awarded a specific geographic jurisdiction to process Medicare Part A and Part B claims for Fee-For-Service (FFS) procedures and Durable Medical Equipment (DME) beneficiaries. Your local MAC will provide links to help walk you through the process. 

The easiest way to revalidate is to go to the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) website. You also can submit your revalidation on paper to your MAC, using the CMS-855 form. Revalidation can occur on an individual or organizational basis. CMS has prepared a revalidation checklist to support providers in this process. This checklist details what individual providers and organizations must submit in order to complete the revalidation process. 

Providers working in a hospital setting, under a managed-care organization or multiclinic practice, should ask their administrator if they should file for revalidation on an individual or organizational basis. 

Can I Revalidate Early, Before My Due Date?

No. If you have not received a notification from your MAC but suspect you need to revalidate, or if you see a TBD (to be determined) when you check your status on the Lookup Tool, it is considered an unsolicited application, and will be returned to you by your MAC.

What Happens If I Don’t Revalidate?

Failure to complete the revalidation process will result in deactivation of your Medicare enrollment, and you will lose the ability to bill Medicare for services rendered. If your Medicare enrollment is deactivated, you will be required to resubmit a full application in order to reestablish your Medicare billing privileges.

Helpful Websites

The Academy also encourages audiologists to review Medicare Enrollment guidance document (see website below) developed by CMS for additional information. This document reviews initial Medicare enrollment, including how to obtain a National Provider Identifier (NPI) number and use the PECOS website, as well as the process for Medicare revalidation.